Study of total colonic motility in progressive systemic sclerosis (P.S.S.) and in hypotonic constipation

Progressive systemic sclerosis (P.S.S.) alters smooth muscle function throughout the gastrointestinal tract with organic disturbance. It is well known that this decrease induces hypomotility of the colon. The other hands, hypotonic constipation is based upon hypomotility of the colon, but not organic disturbance. But there is no report concerning difference of motility determind in the several parts of the colon. The polyethylene tubes were inserted into the ascending colon (A), and splenic flexure (Sp) an dsigmoid colon (S) through colonofiberscope, and then the intraluminal colonic pressure was measured in total colon includong proximal solon, after intramusclar injection of neostigmin, in 8 patients with P.S.S., 4 patients with hypotonic constipation and 6 volanteers as the control. In 6 controls, motility index (M.I.) decreased from A to S (S＜Sp＜A) (A＜S : p＜0.01, Sp＞S : p＜0.05). In 5 out of 8 patients with mild systemic manifestation of P.S.S. (mild P.S.S.), neostigmin increased the motility of total colon and the changes of M.I. from A to Sp indicated the reverse gradient which is different from controls. In 3 out of 8 patiwnts with severe manifestation of P.S.S. (severe P.S.S), neostigmin could not stimulate the motility of total colon and the gradient of M.I. from A to Sp was same as mild P.S.S. (A＜Sp). Total colonic motility was paralle to the severity of P.S.S., but the motility of A was lower in spite of severity of P.S.S.. In patients with hypotonic constipation, neostigmin did not stimulate total colon in motility and the M.I. in each position was the lowest with no difference among 3 parts.